What Exactly is “Evidence-Based Treatment” and is it Actually More Effective?
What Exactly is “Evidence-Based Treatment” and is it Actually More Effective?
by Kayla Gill on September 21, 2021
Many rehab centers tout their treatment methods as being “evidence-based.” But what exactly does this mean, and does this actually make these therapies more legitimate than others?
Today, there are so many kinds of treatments for substance use and mental health disorders that it can feel overwhelming to decide which is best for you. And in fact, it’s completely normal not to know which type of therapy will suit you best until you gain some exposure during the treatment process.
Some rehab professionals determine the effectiveness of certain types of addiction and mental health treatments by analyzing their clinically proven outcomes. Generally speaking, therapies that have been proven to some degree by scientific research are referred to as “evidence-based.”
If you’re concerned with scientifically proven outcomes, you may want to consider looking for an addiction treatment program that emphasizes evidence-based practice. Keep in mind, though, that not all evidenced-based therapies are necessarily effective, just as not all effective treatments are evidence-based.
Ultimately there are many variables, both personal and environmental, that can affect the success of any treatment or rehab program regardless how much evidence supports it. Researching different treatments or recovery programs is a great way to get a sense for whether a program aligns with your personal beliefs and recovery goals. Below you’ll find more information about evidence-based treatment (EBT), including:
Aspects of evidence-based practice are referred to by several similar terms. Some of these are used interchangeably, though they do have different meanings and applications.
In general, “evidence-based” refers to anything that’s proven effective according to objective, scientific evidence. The Netherlands based Center for Evidence-Based Management1 states that evidence is “information, facts or data supporting (or contradicting) a claim, assumption or hypothesis.” Below, we define a few of the most relevant terms.
EBT is any treatment whose use and effectiveness is supported by scientific evidence as established through research and clinical trials. In other words, the label EBT refers to “treatments or services for one specific problem that have met established standards of research quality and outcomes,”2 as described in a recent article published by a U.S. graduate university, the Smith College School for Social Work. For example, cognitive behavioral therapy (CBT) is consistently proven to be effective for treating anxiety disorders.3
Note, in the research community, an evidence-based treatment can also be referred to as an empirically supported treatment (EST) or an empirically supported practice (ESP). The acronym EBT may also sometimes be used to refer to “evidence-based therapy,” depending on the source.
For the purposes of this article, EBT is used to refer to evidence-based treatment, especially as it applies to addiction.
EBP is a broader and more encompassing term. According to Smith College’s James Drisko, EBP is a process that “integrates the client’s needs, values and preferences with relevant research evidence2 and clinical expertise into health care decision-making.” That is, a medical professional who follows this practice will consider scientific findings, their own clinical experience, and the client’s desires when prescribing or recommending treatments, therapies and medications. Evidence-based treatments, like cognitive behavioral therapy, can be an important part of the EBP process, but not all evidence-based practices use or prescribe EBTs.
Note that you’ll also see the acronym “EBP” used in the fields of psychiatry and psychology, but typically in these cases it refers to “evidence-based psychotherapy.”
Evidence-based medicine uses scientific tools “to evaluate the safety, effectiveness, and cost of medical practices5 in treating patients,” as defined in the Journal of Health Politics, Policy and Law, published by Duke University. According to the same journal, EBM is an alternative to medicine based on “authority, tradition, and the physician’s personal experience.”
A revised definition, published by UK-based medical trade journal The BMJ describes EBM as “a systematic approach to clinical problem solving6 which allows the integration of the best available research evidence with clinical expertise and patient values,” much like evidence-based practice.
Evidence-based treatments are attractive options for many and offer several benefits. Some people feel more confident knowing the treatment they’re receiving has been tested and proven to be effective enough to be classified as an EBT. Below are a few of the foundational principles and benefits of evidence-based treatments.
EBTs are based on years of research and study. Usually studies that establish EBTs must be able to be replicated. Findings from these studies, therefore, are very comprehensive and are generally supported by results from multiple sources. And because they should be easily reproduced, many EBTs have detailed instructions for implementation that providers can reference.
Furthermore, EBTs are established through a specific process that outlines what steps clinicians and scientists should follow for testing. These 7 steps of evidence-based practice7 are outlined in the U.S. American Journal of Nursing.
The scientific evidence that supports the use of EBTs typically comes from strict trials. In the scientific and research communities, many publications and research institutions believe randomized controlled trials (RCT) produce the best scientific evidence to prove a treatment’s effectiveness8 and to detect “the harm and the inefficacy of others in comparison with the best existing therapy,” as described in the Journal of Academy of Medical Sciences of Bosnia and Herzegovina.
Some research, like that from global academic journal Health Policy, claims that RCTs produce the highest quality of evidence9 because they are “the least subject to bias.” In other words, by testing new treatments in real-world settings, RCTs may help scientists and researchers overcome personal and professional biases to discover what treatments actually work or don’t work.
EBTs are recognized and implemented in many countries around the world. In recent years many government organizations have recognized the value of EBTs in the use of addiction recovery programs. This has led to some legislative mandates, such as an evidence-based practice mandate in the state of Oregon10, which “ties state funds to specific treatment practices,” as explained in the U.K. based international Journal of Psychoactive Drugs. In 2006 the U.K. government launched an initiative called Improving Access to Psychological Therapies (IAPT) for depression and anxiety disorders, which established clinical services offering evidence-based psychological therapies11 recommended by the National Institute for Clinical Excellence (NICE) and which was evaluated by the international peer-reviewed journal, Behaviour Research and Therapy. In 2005, the United Nations Office on Drugs and Crime established Treatnet, a network of 20 drug dependence treatment resources12 around the world, to promote the use of and increase access to evidence-based addiction treatment practices.
EBTs can help treat multiple issues at the same time. Many times people struggling with substance use disorders also need therapy for mental health disorders and underlying traumas. One key benefit of many evidence-based treatments is how they simultaneously help people recover from multiple disorders, improving treatment outcomes and chances of recovery.
Not all patients, or even behavioral health professionals, prefer evidence-based therapies. One reason for this is because the process for evaluating and classifying something as “evidence-based” is debatable and can even be seen as subjective. EBT does have several limitations that could make treatment seekers consider other avenues for addiction recovery.
The results that EBTs are based on aren’t 100% reliable or applicable. While many evidence-based treatments and medicines are discovered because of RCTs, that doesn’t mean that RCTs are the only means of determining what’s “evidence-based” or not. Like any study conducted by humans, RCTs can have design and implementation flaws13 which lead to ethical and practical concerns in relying too heavily on their use to establish evidence. For example, the Swedish-founded Journal of Internal Medicine explains that for a RCT to determine the efficacy of a treatment,14 it should enroll “an adequate number of patients and utilize appropriate methodology to minimize the possibility of non-systematic and systematic deviations from the truth.” Because the standards of RCTs can’t always be controlled, studies should be evaluated “by appropriate criteria,15 and not primarily according to the simplistic RCT/non-RCT dichotomy.”
Scientists and rehab professionals do recognize that evidence is an important factor to consider when making treatment decisions. But even if the evidence comes from other types of studies (not just RCTs), Mark Tonelli, MD, MA of the American Medical Association (AMA) argues that “empirical evidence derived from clinical research is neither prescriptive16 nor does it always trump experiential knowledge or physiologic reasoning.”
Studies leave out other, potentially equally valid types of treatment. Much of the evidence used to support EBTs is derived from studies and trials that don’t include non-EBTs like community-based treatment programs or other complementary treatments, like holistic drug and alcohol rehab therapies. “Despite some striking examples of strong collaborations between community-based drug and alcohol abuse treatment programs and research institutions, it was apparent that relatively few investigators work closely with community treatment programs,17 and even fewer programs participate actively in research,” finds the U.S. Institute of Medicine (US) Committee on Community-Based Drug Treatment.
Because of this exclusion from scientific research and studies, a treatment’s effectiveness shouldn’t necessarily be based on empirical research. As an article from Health Policy describes, “Certain easily or already well-standardized approaches to addiction treatment are more likely to be tested in RCTs (e.g., pharmacotherapies, cognitive behavioral therapy), thereby biasing the pool of available interventions by including only those that have generated the most scientific interest,” but “the absence of efficacy studies does not render an intervention approach ineffective.”9
Individual patients may differ from, and be more complex than, study subjects. People who participate in scientific studies are usually chosen based on strict criteria. Because of this, it’s important for clinicians to recognize that, as one article published in JAMA medical journal states, real-life patients are “rarely identical to the average study patient.” Sometimes these differences lead to a gap between “the kind of knowledge that we derive from clinical research and the kind of knowledge we need to provide optimal care to an individual16,” says Mark Tonelli, MD, MA, in the American Medical Association’s Journal of Ethics. “Application to individual cases requires clinicians to ask whether the patient-at-hand differs in any meaningful way from the ‘average’ patient of the clinical trial. Value judgments must enter into the calculus at this level as well.”
As the Journal of Internal Medicine further explains, “Clinical expertise is required to establish, balance and integrate the patient’s clinical state and circumstances, preferences and actions18, and the best research evidence.” No matter which kind of addiction treatment you seek, a rehab’s staff and medical professionals should conduct a full evaluation in order to take your unique set of problems into account while tailoring an addiction treatment plan19 for your individual recovery goals, like the U.K. based Philosophical Transactions of the Royal Society Biological Sciences journal advises.
There are a lot of types of substance use and mental health disorder treatments that aren’t classified as EBTs. Just because their effectiveness may not necessarily be measurable or backed by large bodies of scientific evidence, doesn’t mean they aren’t still useful (or even effective). Non-evidence-based treatments and therapies still have their place in overall treatment and may still be an effective option for you.
Mindfulness, for example, is a complementary, integrative treatment used in many rehab programs. In fact, Mindfulness-Oriented Recovery Enhancement (MORE)20 is a treatment approach that “unites traditional mindfulness meditation practices with techniques from cognitive behavioral therapy and principles of positive psychology.” In a presentation for the U.S. National Center for Complementary and Integrative Health, Eric Garland, MD, explains that MORE is designed to reduce addictive behavior and is proven effective for chronic pain and opioid abuse.
The Clinical Psychology Review, a U.S. based academic journal, analyzed mindfulness-based interventions for depression, pain conditions, smoking, and addictive disorders21 and found that results from some mindfulness treatments didn’t significantly differ from evidence-based treatments. The report’s conclusions support the notion that “mindfulness-based interventions hold promise as evidence-based treatments.”
And this is just one example of a different, “non-evidence-based” treatment that has been beneficial for many on their journey to recovery.
In the field of substance use and mental health disorder treatment, there are many different approaches to recovery. What works for one person may not work for another. For some, scientific evidence is an important factor in choosing a treatment and rehab center.
If you’re interested in finding treatments that have been tested and proven to be effective in clinical settings, browse luxury rehabs that offer evidence-based treatment for addiction here.
Reviewed by Lisa Misquith